Preventing Central Line Associated Bloodstream Infections

In 2009 while addressing the National Patient Safety Goal (NPSG) to prevent CLABSIs, the Bloodstream Infection (BSI) Prevention Workgroup was established. The workgroup was tasked with evaluating components of the NPSG, which included the latest evidence-based practices that had been proven to reduce CLABSIs. The BSI Prevention Workgroup established a “bundle” of practices that should be performed for each central line that is inserted at Georgia Regents Medical Center.

The Central Venous Line (CVL) Bundle consists of 5 main components. They are:

Hand Hygiene (Before insertion and with maintenance)Skin Antisepsis with chlorhexidine gluconate (CHG)Site Selection (subclavian site preferred; femoral avoided in adults)Maximum Sterile Barriers (Items used to prevent contamination of the line during insertion)Daily Review of Line Necessity (prompt removal when no longer needed)

Education is provided by the Department of Hospital Epidemiology on the CVL Bundle to medical staff credentialed to insert central lines. An observer who has also been through the education must observe each insertion to ensure that the above elements were done during the procedure, as well as ensuring that aseptic and sterile techniques are maintained. Central lines inserted with an observer present who has verified that all the bundle elements were used are considered “certified” lines. Central lines which are not certified are removed within 24 hours unless there is justification for not following the bundle.

As the BSI Prevention Workgroup developed policies, procedures, and processes (including procurement of supplies) to implement the bundle, the group identified the need for a dedicated vascular access team (VAT). A team already existed in a limited capacity for pediatric patients. In 2010, funds were allocated for expansion of the Pediatric VAT, and the establishment of an Adult VAT. For more information on the Adult and Pediatric VATs.

Historically, only intensive care units (ICUs) were monitored for CLABSIs at our facility. This was in line with established infection prevention guidelines, as well as reflected the trend of central lines being limited to these units. As medical care has advanced, central lines are now seen in all areas of care. In October 2010, we began to add our general nursing units to our CLABSI surveillance plan. We are now monitoring all of our inpatient units (general and intensive) for CLABSIs.

As reflected in the attached graph, the number of CLABSIs in our ICU patients has dropped significantly. As data is provided through our new surveillance of CLABSIs in all of our inpatient units, we continue to look for opportunities for the reduction of CLABSIs, particularly in the general nursing units.

As part of a national initiative to reduce all healthcare acquired infections (HAIs), Georgia Regents Medical Center has transitioned the BSI Prevention Workgroup to the Healthcare Acquired Infection (HAI) Prevention Team. The HAI Prevention Team is working with a national collaborative, hospital engagement network (HEN) through the Centers for Medicare and Medicaid Services to reduce all HAIs forty percent by 2013. The team’s goal is to replicate the success of the BSI Prevention Workgroup with other HAIs, such as catheter associated urinary tract infections, ventilator associated pneumonia, and surgical site infections. With the dedication of such a committed group, our goals for eliminating these never events is highly achievable.